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2 NT Department of Health Office of the Chief Nursing and Midwifery Officer NT Department of Health Preferred citation: NT Department of Health 2013 Strategic Plan for Nurse Practitioners in the Northern Territory Northern Territory Government, Darwin An electronic version of this document is available at:

3 Strategic Plan for Nurse Practitioners in the Northern Territory

4 Foreword Nurses are the backbone of our health system in the Northern Territory and I am pleased to provide a Strategic Plan for Nurse Practitioners. The Northern Territory aims to be a leader in developing and supporting Nurse Practitioners, to improve health outcomes within our unique urban, regional and remote health workforce. The Strategic Plan for Nurse Practitioners sets out the Territory Government s commitment for Nurse Practitioners to play an integral role in health service delivery within our social, cultural and environmental context. Nurse Practitioners provide high quality and cost effective care, and will be a key part in the government s commitment to health reform across the Territory. This includes streamlining the patient journey between acute and primary health care services. Nurse Practitioners in remote areas are invaluable in health delivery to enhance outcomes, particularly for children, chronic disease management including diabetes and heart disease, and mental health. Our strategy for Nurse Practitioners will ensure that Nurse Practitioner positions will be created in areas that will have the most impact on improving health outcomes and where these roles will work most effectively within the multidisciplinary team. I have endorsed a target of creating an additional 25 full time positions by 2016, with further work planned to increase opportunities for nurses to progress their careers. The Hon. Robyn Lambley NT Minister for Health PAGE 4

5 Introduction There is international and national evidence that Nurse Practitioners have the capability to provide services that have a significant positive impact on the health outcomes for consumers. However, the rate of implementation of the Nurse Practitioner role across Australia has varied. The Strategic Plan for Nurse Practitioners in the Northern Territory describes the role of the Nurse Practitioner and articulates the commitment to increase the number and function of these roles in this jurisdiction. Working both autonomously and collaboratively within the multidisciplinary team in advanced and extended roles, the Nurse Practitioner has a scope of practice that builds on the platform of the Registered Nurse scope of practice. There is a strong commitment to develop the Nurse Practitioner role within the Northern Territory health workforce in order to have the highest possible impact on Closing the Gap between the health of Indigenous and non-indigenous people and to improve the health outcomes of all Territorians. By taking a strategic approach, Health Services will be the driving force behind identifying where these positions are required. Suitable Registered Nurses will then be identified and supported, firstly as Nurse Practitioner Candidates and then as Nurse Practitioners employed in substantive roles within Government and non-government Health Services. The strategic approach will ensure an effective and sustainable approach to the development of a Nurse Practitioner workforce in the Northern Territory Dr Robyn L Aitken Acting Chief Nursing and Midwifery Officer PAGE 5

6 What is a Nurse Practitioner? Under section 95 of the Health Practitioner Regulation National Law Act Nurse Practitioner is a protected title in Australia. This title can only be used by a Master s prepared registered nurse who is endorsed by the Nursing and Midwifery Board of Australia (NMBA) to function autonomously and collaboratively in an advanced and extended clinical role using nursing knowledge and skills (ANMC 2006, National Health Determination, 2010, NMBA 2011). What does a Nurse Practitioner do? Nurse Practitioner practice is an extension of advanced practice nursing beyond the scope of practice of a Registered Nurse. It is characterised by the application of dynamic practice, professional efficacy and clinical leadership (ANMC 2006). The Nurse Practitioner s extended practice includes, but is not limited to, advanced and comprehensive health assessment, ordering and interpreting diagnostic investigations, differentiating a diagnosis, prescribing medications, establishing a collaborative therapeutic management plan, and direct referral of patients to other health care professionals. Scope of Practice The scope of practice of a Nurse Practitioner is defined by the: Relevant National and Territory acts, legislation and service agreements Health care needs of the population Clinical specialty of the NP Model of care Workforce capacity/profile Health care context PAGE 6

7 Context of the NT was to address gaps in service provision, particularly to underserved/ disadvantaged sections of the community who have limited access to adequate healthcare, or to increase productivity by extending the role of the nurse amongst a group of health care practitioners within a health care service. It was anticipated that introducing Nurse Practitioner roles to rural and remote contexts would particularly address these aims. THE CONTEXT OF THE NT NT Population: 229, 711 (2010 ABS) Population of 229, % of the NT population (2010 ABS) is Aboriginal compared to around 3% Nationally (2006 Census) 30.4% of population is 44% of the Northern Territory Aboriginal population compared lives to in around remote or 3% very Nationally remote areas compared to 2% in (2006 Census) Australia (ABS, 2010) The remaining NT population 44% of lives the in Northern Darwin Territory (outer population regional) NT lives has a in population remote or very density remote of 0.16 areas people/ km compared 2 compared to 2.78/ km to 2% in 2 nationally Australia (2006 census) The rest in Darwin (outer regional) Population density of 0.16 people/km2 compared to 2.78/km2 nationally 5 P age PAGE 7

8 NT Population Profiles The NT Indigenous and Non-Indigenous populations have two distinct age profiles. The non-indigenous population appears as the blue lines on the left. The pyramid starting at the bottom represents local people who are born here, work here and the small number who retire here. The bulge represents the working population who come to the NT to work and leave when they have finished working. The point of both triangles represents the population older than 60 years and is indicative of an exodus from the NT later in life for both groups within the non- Indigenous population. Northern Territory Population Pyramid by Indigenous status , 2011, and & 2031 Population Profiles However, this trend is predicted to change in the next few decades. There is a projected increase in people of retirement age who are anticipated to stay in the NT and who will require access to more health services close to home. The NT Indigenous population is represented as a single yellow/orange/red triangle on the right hand side. It clearly shows that Indigenous people have lower life expectancy compared to non- Indigenous people in the NT. There are also typical signs of epidemiological transition. Improved perinatal care has decreased maternal and infant mortality, yet significant chronic disease in middle aged adults results in reduced life expectancy, especially for Indigenous males. National health outcome targets are contextualized to both population distribution and demographic profiles in the NT. PAGE 8

9 Health outcome targets Achieving targets for Indigenous children under 5 years of age in the NT in both remote communities and in urban centres of Darwin, Alice Springs, Tennant Creek, Katherine and Nhulunbuy is a priority. There is much evidence identifying the health problems within the under-3 year age group, which have serious consequences in terms of cognitive development, poor educational outcomes, and chronic disease (including intellectual disability) later in life. High rates of infectious diseases such as rheumatic heart disease, trachoma and chronic ear infections exist across the lifespan. In the adult population a high burden of sexually transmitted infections, cardiovascular disease, renal disease, diabetes, mental health problems and the contributing lifestyle factors of smoking, substance misuse and obesity contribute to early deaths. Nurse Practitioners improve health outcomes by addressing health service needs Nurse Practitioners have been providing care to individuals, families and communities since the 1960s when they were introduced into the primary health care setting in the United States. The Nurse Practitioner role was introduced in Australia in An essential tenet of introducing the Nurse Practitioner as a classification within the Australian healthcare system was to address gaps in service provision, particularly to underserved/disadvantaged sections of the community who have limited access to adequate healthcare. Increasing productivity by extending the role of the nurse amongst a group of health care practitioners within a health care service was also an underpinning goal. It was anticipated that introducing Nurse Practitioner roles to rural and remote contexts would particularly address these aims. Nurse Practitioners and Closing the Gap Significant improvements in health outcomes have been achieved internationally through primary health care initiatives that include implementing and integrating Nurse Practitioners into the health workforce. Nurse Practitioners in the NT will make a substantial contribution to closing the gap between Indigenous and non-indigenous health. A large body of national and international research provides evidence that an NP workforce functioning beyond the role of a Registered Nurse can address health needs in a financially viable, high quality way which is also highly acceptable to health consumers. PAGE 9

10 The Nurse Practitioner role is dynamic and responsive to the needs of clients. As a member of the health care team, Nurse Practitioners have demonstrated the ability to improve consumer/ community access to expert health assessment, diagnosis and management of a person s health needs within a specific field of nursing, or within a particular population group. Strategic workforce planning There are currently limited numbers of Nurse Practitioners employed within both Government and non-government health services in the NT. The Health Care Reform Agenda provides a unique opportunity to integrate the Nurse Practitioner role within the NT nursing workforce structure, drive workforce reform to close the gap between Indigenous and non-indigenous health, and achieve better health outcomes for all Territorians. Where organisations have worked strategically to match health service needs, preparation of Registered Nurses as Nurse Practitioners with a specific scope of practice, and designation of Nurse Practitioner positions there has been a high level of success in implementing Nurse Practitioner roles. PAGE 10

11 Essential elements The essential elements of the Strategic Plan for Nurse Practitioners in the NT include: Identifying priority areas so that Nurse Practitioner positions are implemented in sites where they are of most benefit to achieving improved health outcomes Ensuring the scope of practice of each nurse practitioner is complementary to the clinical care provided by other members of the multidisciplinary team Implementing governance systems that comply with national and local regulations, align with standards of quality and safety, and ensure services provided to the public by Nurse Practitioners are delivered according to best practice standards Working with educational providers to prepare graduates for practise in specific extended practice roles. Implementing the plan The Office of the Chief Nursing and Midwifery Officer (CNMO) will work closely with health service executives, service directors, and clinical leaders (Nursing, Medicine and Allied Health) within government and non-government organisations to form implementation working groups (IWGs). The IWGs will identify gaps in service, undertake financial modelling, and formulate governance structures for redesigning the workforce to integrate the Nurse Practitioner role within the health care team to achieve better health outcomes for all Territorians. Key Performance Indicators (KPIs) will be identified to evaluate improved health outcomes based on health priority areas. The implementation plan formulated by the IWGs will be submitted to the Office of the CNMO for: Designation of nurse practitioner roles Authorisation of nurse practitioner scope of practice in the designated role; and Approval as compliant with the NT Nurse Practitioner Clinical Governance Framework PAGE 11

12 Priority health service areas Priority service areas identified for expanding or initiating designated Nurse Practitioner positions include: Remote primary health care clinics Specialty outreach services (child health and chronic disease) Urban community and remote outreach mental health services Urban community alcohol and other drug (AOD) services Urban community child health and chronic disease services District hospital emergency departments Nurse Practitioners in the community Extended practice skills incorporating MBS billing, diagnostics, prescribing and referral, mean that nurse practitioners in the urban community health setting can provide one-stop-shop care at first point of contact across the continuum of the lifespan. Nurse Practitioners can enhance access and streamline service delivery in the urban community setting. Priority areas for integrating the Nurse Practitioner role within the community health workforce include case management and public health initiatives for child health, women s and men s health and chronic disease management (including diabetes, heart disease, renal therapies, wound management, alcohol and other drugs (AOD) and mental health). PAGE 12

13 Nurse Practitioners in remote communities A priority context for incorporating the Nurse Practitioner role within the health care team is remote and Indigenous communities. Resident primary health care nurse practitioners and outreach health development and mental health nurse practitioners can both conduct and autonomously act upon comprehensive adult, women s, men s and child health checks, and develop and implement chronic disease management plans. They will not substitute remote medical practitioners, but can address critical health needs. In the context of a shortage of doctors, workforce redesign using nurse practitioners can ensure the most expedient and financially sustainable use of medical resources to enhance access in remote and Indigenous communities. Workforce redesign A sustainable model for delivering priority health outcomes Workforce redesign that incorporates the full spectrum of Registered Nurse classifications within the career structure and optimises the contribution of nurses within the multidisciplinary health care team is critical to this strategic plan. A career pathway linking education and clinical experience is an essential requirement to provide a pipeline to fill designated Nurse Practitioner positions that are driven by service needs and health outcomes targets. The plan also involves aligning recruitment processes with the work of redesign. Growing our own NT Nurse Practitioner workforce is a key recruitment and retention initiative. Student Yr 1 Grad Graduate N3 CNS N4 N5 NPC N6 NP BNurs GNP Grad Dip Consolidation & CPD Advanced Practice Master of Nursing (NP) Consolidation and CPD PAGE 13

14 Education The Office of the CNMO is working closely with Charles Darwin University and the Centre for Remote Health (a joint centre of Charles Darwin University and Flinders University) to ensure that the new combined Master of Nursing: Nurse Practitioner meets the requirements of preparing Nurse Practitioners in line with the national health reform agenda. The redesigned course has a specific emphasis on preparing Nurse Practitioners for the health priorities of closing the gap between Indigenous and non-indigenous health in acute and Primary Health Care contexts and transitional roles that bridge these two sectors. Link to Course information Facilitating Nurse Practitioner candidature Implementing a Nurse Practitioner candidate program that fulfils both workforce requirements and the educational requirements associated with the transition from an RN to Nurse Practitioner scope of practice requires significant investments from the candidate and the employing health service. The NT strategic plan for Nurse Practitioners includes adopting strategies that have proven outcomes in jurisdictions that have been successful in implementing Nurse Practitioner roles. These strategies include: Scholarships Time release and backfill Travel and Accommodation allowances The Office of the CNMO coordinates the Nursing and Midwifery Studies Assistance Grants, which will contribute financial assistance to eligible candidates. NT nurses can also apply for scholarships such as the Commonwealth Rural and Remote Scholarships administered by the Australian College of Nursing PAGE 14

15 Further Information Establishing a designated Nurse Practitioner position within a health service: Under the strategic workforce plan, Nurse Practitioners will be employed across the NT in a range of practice settings. Health Services are responsible for establishing the target nurse practitioner positions by utilising the NP Designation Pack, and assistance provided by the Office of the CNMO. Employment as a Nurse Practitioner or Candidate All vacancies are advertised on the NT Government website. Vacancies in non-government health services are advertised on-line and in national and local print media. If you are a registered nurse and interested in becoming a Nurse Practitioner, you should discuss the options and opportunities with your local nursing management team or contact the Office of the CNMO on More information about becoming a Nurse Practitioner The best place to start is the Nursing & Midwifery Board of Australia PAGE 15

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